Yun Liu, Liqun Wu, Shuqi Yao, Chunxiao Wu, Liming Lu, Wei Yi
Clinical Medical of Acupuncture, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine.
Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, PR China.
Medicine (Baltimore). 2019 Jul;98(29):e16463. doi: 10.1097/MD.0000000000016463.
Acupuncture is widely used for infertile women without undergoing assisted reproductive techniques (ART) in China but its effect is unclear. We aim to assess whether acupuncture and its combined therapy exert a positive influence on the outcome of female fertility.
We searched 6 databases, including Medline, EMBASE, the Cochrane Central Register of Controlled Trials, the China National Knowledge Infrastructure (CNKI), the China Science and Technology Journal Database (VIP), and Wan-Fang Data, from inception to June 2018. Studies of randomized controlled trials (RCTs) on women with infertility treated by acupuncture or its combined therapy were included. A meta-analysis was performed using Revman 5.3. The methodological quality of the studies was assessed through the risk of bias assessment tool by the Cochrane Collaboration.
The pregnancy rate was significantly improved with treatment (RR = 1.84, 95% CI 1.62 to 2.10, P < .00001), compared to that in the control group. Subgroup analysis showed that comparing with pure western medicine intervention, no matter intervention with acupuncture alone, with acupuncture plus western medicine, with acupuncture plus Chinese medicine, or acupuncture plus Chinese medicine and western medicine, all of these subgroups exhibited significant improvement. The subgroup according to different types of infertility showed a significant improvement in infertility caused by polycystic ovary syndrome, tubal infertility, ovulatory disorder, and other factors. In addition, the ovulation rate and endometrial thickness were significantly increased. The level of LH was obviously decreased. Moreover, with acupuncture, less adverse effects occurred. The funnel plot revealed that publication bias might exist. All trials included had unclear risks in the aspects of allocation concealment, blinding of participants and personnel, blinding of outcome assessment, selective reporting, and other bias. Only 1 study was assessed as unclear risk in random sequence generation. In the incomplete outcome data, all studies were low risk, except 1.
Acupuncture and its combined therapy may be effective for treating female infertility. However, the included studies are not robust enough to draw a firm conclusion due to the not robustly sampled quality of the included studies. Future high-quality RCTs are needed to confirm our findings.
在中国，针灸被广泛应用于未接受辅助生殖技术（ART）的不孕女性，但疗效尚不清楚。我们旨在评估针灸及其联合疗法对女性生育结局是否产生积极影响。
我们检索了6个数据库，包括Medline、EMBASE、Cochrane对照试验中央注册库、中国知网（CNKI）、中国科技期刊数据库（VIP）和万方数据，检索时间从建库至2018年6月。纳入关于针灸或其联合疗法治疗不孕女性的随机对照试验（RCT）研究。使用Revman 5.3进行荟萃分析。通过Cochrane协作网的偏倚风险评估工具评估研究的方法学质量。
与对照组相比，治疗组的妊娠率显著提高（RR = 1.84，95%CI 1.62至2.10，P <.00001）。亚组分析表明，与单纯西医干预相比，无论是单独针灸干预、针灸加西医、针灸加中医，还是针灸加中医和西医，所有这些亚组均显示出显著改善。根据不同类型不孕进行的亚组分析显示，多囊卵巢综合征、输卵管性不孕、排卵障碍及其他因素导致的不孕均有显著改善。此外，排卵率和子宫内膜厚度显著增加。促黄体生成素（LH）水平明显降低。而且，针灸治疗的不良反应较少。漏斗图显示可能存在发表偏倚。所有纳入试验在分配隐藏、参与者和人员的盲法、结局评估的盲法、选择性报告及其他偏倚方面的风险均不明确。只有1项研究在随机序列产生方面被评估为风险不明确。在不完整结局数据中，除1项研究外，所有研究均为低风险。
针灸及其联合疗法可能对治疗女性不孕有效。然而，由于纳入研究的样本质量不够可靠，现有研究不足以得出确凿结论。未来需要高质量的RCT来证实我们的发现。
